Browsing by Author "Singh, J"
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Publication Awake Fiberoptic Intubation in Cervical Spine Injury: A Comparison between Atomized Local Anesthesia versus Airway Nerve Blocks(Kathmandu University, 2018) Singh, J; Shakya, S; Shrestha, B; Subedi, B; Singh, PBABSTRACT Background In cooperative patients with cervical spine injury, awake fiberoptic intubation is an excellent option for elective and semi urgent situations. It allows documentation of neurologic examination before and after intubation and surgical positioning. We have compared anesthesia of airway by nerve block and the local anesthesia atomizer undergoing awake fiberoptic intubation in cervical spine injury patients, in terms of the intubation time and discomfort. Objective To compare the intubation time and discomfort in patient with cervical spine injury with anticipated difficult airway potential to aggravate pre-existing injury undergoing awake fiberoptic intubation, based on cough and gag scores, between anesthesia of airway by (transtracheal and bilateral superior laryngeal) nerve block with local anesthetic agent and the local anesthesia atomizer. Method After institutional ethical approval and having informed written consent, 30 patients scheduled for elective surgery who require awake fiberoptic intubation, were included in the study. Patients were allotted by computer-generated random series into two groups; Group N received nerve block (transtracheal and bilateral recurrent laryngeal nerve block) and Group A received atomized lignocaine. Result The time taken for awake fiberoptic intubation was significantly lower in nerve blocks group as compared with the atomizer group [Group N: 90.2±11.7secs and Group A: 210.4±10.6 secs (p=0.041)]. Atomizer group had an increased coughing and gagging episodes than nerve block group [Group N: one patient, Group A: 11 patients (p=0.006)]. Ease of intubation and patient comfort were significantly better in nerve block group. Demographic and hemodynamic parameters were comparable in the two groups. Conclusion The nerve blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal) provides adequate airway anesthesia, lesser patient discomfort, and faster intubation to aid in awake fiberoptic intubation in patients with anticipated difficult airway as compared to topical anesthesia using atomizer. KEY WORDS Awake fiberoptic intubation, Cervical spine injury, Laryngeal nerve block, Local anestheticPublication Comparison of Ketamine, Fentanyl and Clonidine as an Adjuvant During Bupivacaine Caudal Anaesthesia in Paediatric Patients(Kathmandu University, 2012) Singh, J; Shah, RS; Vaidya, N; Mahato, PK; Shrestha, S; Shrestha, BLABSTRACT Background Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. Objectives To compare the efficacy of ketamine, fentanyl and clonidine in terms of quality and duration of analgesia they produce when added with caudal bupivacaine by single shot technique in children. Methods Eighty children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of four groups: caudal analgesia with 0.75 ml/ kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group BC) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with ketamine 0.5mg/kg (Group BK) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with fentanyl 1mcg/kg (Group BF). Post-operative pain was assessed for 24 hours using the FLACC scale. Results The mean duration of analgesia was significantly longer in Group BC (629.06 ± 286.32 min) than other three groups P < 0.05. The pain score assessed using FLACC scale was compared between the four groups, and children in Group BC had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group BC. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects in compare to fentanyl or ketamine. Conclusion We conclude that clonidine in a dose of 1 μg/kg, added to 0.25% bupivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for sub- umbilical surgery, significantly prolongs the duration of post-operative analgesia when compared to 0.75 ml/kg of 0.25% bupivacaine in normal saline than 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5 mg/kg or 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg or 0.75 ml/kg of 0.25% bupivacaine alone, without any side effects. KEY WORDS Bupivacaine, caudal analgesia, clonidine, fentanyl, ketamine, post-operative analgesia, sub-umbilical surgeryPublication Effect of preloading on haemodynamic of the patient undergoing surgery under spinal anaesthesia(Kathmandu University, 2010) Singh, J; Ranjit, S; Shrestha, S; Sharma, R; Marahatta, SBAbstract Background: Hypotension and bradycardia after conduction of spinal anaesthesia are common side effects because of sympathetic blockade. Efforts to prevent these complications have been attempted like preloading with crystalloids, colloids or use of vasopressors. The role of volume preloading to prevent haemodynamic changes associated with spinal anaesthesia has been recently questioned. Objective: The objective of the study was to investigate the effects of volume preload on changes of patient’s hemodynamic. Materials and methods: A Quasi- experimental design was used to conduct the study. Taking written informed consent, 40 patients of age group 18-45 years and ASA grade I and II undergoing surgery under spinal anaesthesia in operation theatre of Dhulikhel Hospital were selected as the sample of the study and allocated randomly to 2 groups. Group I did not receive volume preload and Group II received preload of 1000 ml of Ringer’s lactate solution within 30 minutes immediately before giving the spinal anaesthesia. An observational checklist was used to collect demographic, intra- operative and post-operative records of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR). Results: The findings revealed that the haemodynamic changes occurred in all patients. The decrease in SBP, MBP and DBP from baseline was statistically significant at all points of time (p=0.000). The decrease in HR from baseline was not statistically significant at all points of time (p>0.05). The overall incidence of hypotension was 50%, among which 9 (45%) were from without preload group and 11 (55%) were from with preload group. The incidence of hypotension was similar in groups, sexes and surgical conditions (General Surgery, Gynae/Obs and Orthopaedics). There were no signifi cant differences in haemodynamic changes among groups. Conclusion: On the basis of findings, it is concluded that volume preloading had no effect on the incidence of hypotension and bradycardia after spinal anaesthesia. Key words: Preload, Haemodynamics, Spinal Anaesthesia, CrystalloidPublication Musculoskeletal Ultrasonography of Baker’s Cyst in Primary Osteoarthritis of Knee: An Observational study(Kathmandu University, 2024) Shakya, S; Amatya, SP; Singh, J; Shrestha, B; Sharma, BP; Gelal, RABSTRACT Background Knee pain and limitation of joint movement are common compliant in pain clinic due to knee osteoarthritis and often associated with Baker’s cyst. These are usually asymptomatic during the initial phase and might be missed during clinical examination and later may present in complicated form. Musculoskeletal ultrasonography might be helpful in detecting asymptomatic Baker’s cyst during the early course of the disease. Objective To observe the incidence of Baker’s cyst in patient with primary osteoarthritis of knee with the help of routine musculoskeletal ultrasonography of knee during clinical evaluation of patient. Method A total of 114 patients with unilateral or bilateral knee pain diagnosed as primary osteoarthritis of knee were included in this study. Musculoskeletal ultrasonography was performed on all patients to look for the presence of Baker’s cyst. The incidence of Baker’s cyst was the primary outcome of this study. Depending upon the presence/ absence of Baker’s cyst, two groups were formed, and variables were compared between these groups to find the factors associated with Baker’s cyst. Statistical analysis was done using student t-test, ANOVA test and Chi-square test. Result The incidence of Baker’s cyst in this study was 21.1% of the patients and 89.28% were asymptomatic. Baker’s cysts were strongly associated with joint effusion and synovial hypertrophy. Conclusion Baker’s cyst was a common finding in the patient with knee osteoarthritis. Musculoskeletal ultrasound would be a valuable tool to detect such asymptomatic cysts early. KEY WORDS Baker’s cyst, Knee osteoarthritis, Synovitis, UltrasonographyPublication Poisoning cases attending emergency department in Dhulikhel Hospital- Kathmandu University Teaching Hospital(Kathmandu University, 2009) Marahatta, SB; Singh, J; Shrestha, R; Koju, RAbstract Objective: The objective of the present study is to evaluate the characteristics of acute poisoning cases admitted to emergency department over a one year period. The demographic, clinical and psycho-social aspects of the patients were analysed. Materials and methods: A hospital based study was carried out in the emergency department, Kathmandu University Teaching Hospital/ Dhulikhel Hospital, Dhulikhel analysing the data of the poisoning cases attended for one year. The study was carried out amongst inpatients attending emergency with acute poisoning. Results: A total of 54 patients were admitted to the emergency department with acute poisoning. The female-to-male ratio was 1.34:1. Most poisoning occurred in the age group of above 40 years. The mean ages of female and male were 29.87 ±14.85 years and 35.54±15.02 years respectively. By occupation 40.38% of the cases were farmers. Only 35.29% of the patients were illiterate. 79.24% of the cases intentionally consume the poison. Organ phosphorus poisoning (OP) was the most common poisoning. Oral route was the commonest route of poisoning accounting 98.1%. Sixty-six percentage (66.66%) of the cases had the poison stored in their home with 27.7% bought from the market once needed. Among the cases of acute poisoning 5.55% were fatal. Conclusion: The following conclusions were reached: (1) females were at greater risk for poisoning than males, (2) self-poisoning cases constituted the majority of all poisonings, and (3) the main agents of self-poisoning were OP poisoning. Key words: poisoning, insecticides, organophosphorusPublication Supraclavicular Brachial Plexus Block: Comparison of Varying Doses of Dexmedetomidine with Ropivacaine(Kathmandu University, 2021) Shakya, S; Singh, J; Ghimire, A; Shrestha, BABSTRACT Background Alpha-2 adrenergic receptor agonists have been the focus of interest nowadays as an adjuvant to local anesthesia due to its excellent sedative, analgesic, antihypertensive, anesthetic sparing and hemodynamic stabilizing properties. The ideal dose of dexmedetomidine for brachial plexus block is matter of debate. Objective To find the appropriate minimal dose of dexmedetomidine with desired clinical effects and minimal side-effects, we compared different doses (25 mcg, 50 mcg, 75 mcg and 100 mcg) of dexmedetomidine as an adjuvant to ropivacaine. Method One hundred fifty patients of ASA I and II, aged (18-60) years, weighing (50-60) kilograms undergoing upper limb surgeries under brachial plexus block were enrolled in this prospective, double blind, randomized control study. Patients in all group received 19 ml of 0.5% ropivacaine in common. In addition; group RD25, RD50, RD75 and RD100 received 25 mcg, 50 mcg, 75 mcg and 100 mcg of dexmedetomidine diluted in 1 ml of normal saline (NS) respectively whereas group RD00 received only 1 ml of NS. The duration of analgesia was the primary outcome whereas block characteristics, hemodynamic parameters, oxygen saturation, sedation score and adverse effects were taken as secondary outcome. Statistical analysis was done using ANOVA test, Chi-square test and Scheffe’s multiple comparison tests. Result The demographic profile and baseline hemodynamic variables were comparable in all five groups. Increasing dose of dexmedetomidine showed significant improvement in block characteristics but associated with increase in sedation and incidence of bradycardia. Conclusion We conclude that dexmedetomidine 50 mcg would be an appropriate dose as adjuvant to local anesthesia in brachial plexus block. KEY WORDS Analgesia, Brachial plexus block, Bradycardia, Dexmedetomidine, RopivacainePublication Ultrasonographic Evaluation of Inferior Vena Cava: Aorta Index with a Cut-off Value of 1.0 as a Predictor for Hypotension after Induction of General Anesthesia; An observational study(Kathmandu University, 2022) Shakya, S; Shrestha, B; Singh, J; Ranjit, SABSTRACT Background Hypotension after induction of general anesthesia (GA) is common due to pre-existing hypovolemia and has adverse effects on organ function. Out of several methods to predict post-induction hypotension, nowadays Inferior Vena Cava: Aorta (IVC: Ao) index has been studied with different cut-off values. However, limited studies have been performed in our part of the world. Objective To evaluate the efficacy of pre-induction Inferior Vena Cava: Aorta index with a cut- off value of 1.0 for predicting the occurrence of post-induction hypotension after general anesthesia in the Nepalese population. Method A total of 100 patients of ASA I and II, aged more than 18 years posted for elective surgeries under general anesthesia were enrolled in this cross-sectional, observational study. Ultrasonographic guided Inferior Vena Cava: Aorta index was calculated and based on a cut-off value of 1.0, two groups were formed. Seventy patients in group A with Inferior Vena Cava: Aorta index less than 1.0 and 30 patients in group B with Inferior Vena Cava: Aorta index more than 1.0 were enrolled. Vitals parameters were recorded every minute for five minutes after induction of general anesthesia. Incidence of hypotension was the primary outcome. Statistical analysis was done using student t-test, ANOVA test and Chi-square test. Result Inferior Vena Cava: Aorta index with cut-off value of 1.0 predicted post-induction hypotension with excellent efficacy. Total 65 patients developed post-induction hypotension, out of which 63 patients had Inferior Vena Cava: Aorta index less than 1.0. Conclusion We concluded that pre-induction Inferior Vena Cava: Aorta index with cut-off value of 1.0 have high diagnostic accuracy with high degree of sensitivity and specificity to predict hypotension after induction of general anesthesia. KEY WORDS General Anesthesia, Hypotension, Hypovolemia, Inferior vena cava: Aorta index